Enable FHIR CMS Interoperability
8 Plans using our FHIR CMS solution with USCDI and Carin resources
Medicare, Medicaid and Marketplace across 18 states
Processing 10M+ Claims, Enrollments, Eligibility and Claims payment
Reduce Mortality Rate Due to Sepsis
Run Sepsis AI model with real time Vitals, Meds, Labs data
Hospital Remittance & Revenue Management
Reconciling 20M Claims payments per year

The benefits you will get

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About

Why Choose HiPaaS?

We envision HiPaaS to focus on improving patient and revenue outcomes by implementing AI driven use cases.

Sandeep Deokule
HiPaaS CEO.

Product

HiPaaS EDI

Manage Inbound or Outbound Claims 837 I, P, D from various Trading partners, Clearing houses. SNIP Level 1-7 validations. 999 and 277CA generation. Claims Status interfaces. Quickly reconcile rejected claims with mechanisms to route and automate claims edits 277CA transaction response 999, TA1 Responses Account for every $ of claim payment. Reconcile 837 to 835 Payments
Manage Outbound Encounters Submission to State or Medicare, Medicaid. SNIP Level 1-7 validations. 999 and 277CA generation. Outbound Encounters: Generate Encounter data/files from QNXT/System of choice or a staging database. Send validated encounters to state with custom edits. Hold and fix encounters errors. Load responses from different States (EVR, 999, 277CA, 835, text reports). Keep up to date on State validation edits changes Match your encounter edits to inbound Encounter error corrections and Encounter Reporting.
Manage Inbound or Generate Outbound 835 Claims Payments. Reconcile with 837 Claims. Reconcile with Remittance and Treasury and Lockbox.
Implement real time transactions with fastest API driven interfaces integrated with QNXT, Facets and Healthedge for Claims Status 270/271, 276, 274, 278 Pre Auth
Implement 275 Claims Attachments and Clinical attachments
Manage out of box 999, TA1 and 277CA transactions
Out of box integration wiht Availity Clearing house and QNXT for all transactions
Implement all real time transactions with fastest API driven interfaces integrated with QNXT, Facets and Healthedge. 270/271, 276, 274, 278 Pre Auth
Manage inbound and outbound enrollments from state, Medicare and Large groups. Compare with membership data in real time and manage updates. Manage Add, terms, changes, voids, term by absence and various overlapping scenarios. Business workflow UI to pre-scrub and validate prior to loading into membership system 834 Enrollment Validation & Processing Compare & reconcile member data against any membership system. Automate your membership updates including retro changes Ability to fix errors on file and re-submit with configurable validations including: PCP, NPI, zip code vs state/address, Rate code comparison, Aid code, Dual plans validation
Compare Full file from Medicare, state plans with Membership and identify changes
Implement Provider Directory and directory submission
Robust Prior authorization solution for real time and batch 278-11 and 278-13 processing and inquiry. Pega integration
Manage 820 Payments and reconcile with enrollments data
Integrated with HPS enrollments for commercial and group plans to handle multiple coverages.
Manage various other formats for claims, patient data

PRODUCT

CMS FHIR Interop

Enable FHIR Server with USCI and Bluebutton resources. Allergy, Observation, CarePlan, Patient, Encounter, Immunization, Location, Condition, Diagnostic Report, Explanation of Benefits, Procedure and more US Core Extensions mapped
Enable CARIN Profiles. All mandate required CARIN Profiles mapped - Explanation of Benefit, Plan, Claim, Coverage and others
Out of box DVinci use cases. Payer Exchange, Provide Directory, Clinical Use Cases, Formulary Drug and Network Implementation​
Out of box Blue button Implementation. Blue button compatible FHIR resources and server
Payer to Payer interfaces and Integration as per USCDI standards
Use Consent Management 3rd Party Consent Management. App on boarding process. Oauth security
Flows for onboarding 3rd Party FHIR Apps. Validating the app and generating Client secret key.
FHIR Oauth Integration to access API.
Pre-built mappings to healthcare standard extracts for claims, inpatient, professional, pharmacy, provider directory, eligibility, coverage and more..
HiPaaS SHIR CMS repository is in production and already tested with all leading Client Apps

Product

HiPaaS AI Container & HL7 Interfaces: Parex

Send or Receive Healthcare HL7 Messages of different versions
Complete suite of FHIR resources and FHIR Server. Send or receive FHIR messages
All Clinical Data mapped to graph DB and access via REST API - Timeline driven or patient event driven
Support to load Clinical History via CCD, CCDI or XML or rest API data for patient
Artificial Intelligence and Machine Learning containers to collect data, provide data and execute AI use cases
Pre built integrations with leading EHR like EPIC, Athena and others
All you need for checking Eligibility, Claims submission, Coding, Claims payments, Treasury files reconciliation.
Chart extraction, clean up and import modules to transition and migrate to new EHR

product

HiPaaS EDI Lite Cloud

Upload and Validate 837 I, P, D via UI or SFTP folder. View data on UI
Manage out of box 999
Load 835 Claims Payments and Reconcile with Claims data
Implement real time transactions with fastest API driven interfaces integrated with QNXT, Facets and Healthedge for Claims Status
Load and validate 834 Files. View data on UI
Manage 820 Payments and reconcile with enrollments data
Access all enrollment data via API using Oauth
Generate Outbound files using loaded data on criterias

Solutions

Insurance Payers Solutions

Manage Claims from various Trading partners, Clearing houses. SNIP Level 1-7 validations. 999 and 277CA generation. Claims Status interfaces.
Implement all real time transactions with fastet API driven interfaces integrated with QNXT, Facets and Healthedge
Manage inbound and outbound enrollments from state, Medicare and Large groups. Compare with membership data in real time and manage updates
Compare Full file from Medicare, state plans with Membership and identify changes
Implement CMS FHIR Interoperability mandate with easy interfaces to translate EDI data 274, 837 and 834 data. Easy to implement and enable with built in mappings.
Out of box integration with Availity Clearing house and QNXT for all transactions
Integrated with HPS enrollments for commercial and group plans to handle multiple coverages.

Solutions

Hospital Providers Solutions

Reconcile 837 Claims to 835 ERA remittance and Bank files
HETS CMS real time eligibility API, MBI Lookup and  FISS/DDE emulator
Collect real time Vitals, Labs and run AI algorithms to manage cases like Sepsis monitoring, mortality rate monitoring, population health and others
Stream real time HL7 data, FHIR resources and APIs
Context and Chat driven Mobile app integrated with MyChart. Helpful to manage telehealth and chat with clinical st
Collect and analyze patient data in one Graph repository. Connect all HL7, FHIR and Revenue data together.
Coding validation and claims submission, with AI driven Claims module. Reduce claims rejection. Mapped with Medicare covered vs non covered codesets.

HiPaaS Engineering

Kubernetes Cluster

Autoscale with Kubernetes. Deploy on Cloud or On Prem - AWS, Azure and Google supported

Healthcare Neo4j GraphDB

HipaaS Store and retrives healthcare data in Neo4j GraphDB. X12, HL7, FHIR modeling

Healthcare Interoperability Solved

Support for all Healthcare data formats – EDI, HL7, FHIR, NCDP and more. using Boomi

Secure Healthcare API

Everything is Healthcare API. Access any X12, EDI segment or element via API

Our Customers

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